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Insect venom shortage stings allergy sufferers this summer

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As summer begins, signaling peak time for insect stings, allergists across the U.S. are warning of a shortage of a little-known but crucial product — honeybee, hornet and wasp venom extracts used in shots that prevent life-threatening reactions.

Supplies of the extracts — which are made from venom gathered by hand from millions of individual insects — have been scarce since October. That’s when one of two manufacturers in the U.S. shut down production after contamination problems. Doctors say they hope the situation will be resolved, but that’s not likely before next year. For now, they’re rationing doses for patients who need them most.

“It’s going to be a rough summer,” said Dr. David Golden, an allergy expert and associate professor of medicine at Johns Hopkins University.

Golden estimates he’s seen a 25 to 35 percent drop in the supply of venom extracts aimed at preventing dozens, perhaps hundreds, of deaths in the U.S. each year. Between 1 and 3 percent of the country’s adult population — up to 7.4 million people — may have systemic reactions to insect stings, and a smaller proportion have life-threatening responses, experts say.

Most of those vulnerable people carry portable epinephrine — often EpiPens — to quickly counteract symptoms. But a smaller number use what’s known as venom immunotherapy, or VIT, to dramatically reduce the risk of reactions. The treatment, authorized for nearly 40 years, injects small doses of venom under the skin to reduce sensitivity to the allergens that can trigger dangerous symptoms.

“It’s one of the few things that allergists do that actually save lives,” said Dr. Stephen Tilles, a Seattle allergist who is president of the American College of Allergy, Asthma and Immunology (ACAAI). “It’s about 98 percent effective.”

The shortage started last fall, when ALK Laboratories of Denmark shut down production of six types of venom proteins — honeybee, wasp, white-faced hornet, yellow hornet, yellow jacket and “mixed vespid,” a cocktail of venoms.

The move followed a 2016  letter from the Food and Drug Administration citing problems with microbiological contamination. ALK officials didn’t respond to requests for comment.

That left only Jubilant HollisterStier, a Spokane, Wash., company that also produces venom extracts. HollisterStier ramped up manufacturing, Golden said, but the firm couldn’t supply enough venom extract fast enough to avoid a shortage. Firm officials declined to comment.

“Most allergists are having to seriously limit what they use,” Golden said. “We’re trying to stretch the venom that we have.”

This spring, Golden and colleagues issued recommended guidelines for rationing venom during the shortage. They called for spacing out doses at longer intervals, cutting maintenance doses, minimizing venom waste — and stopping treatment for patients at lowest risk for severe reactions.

So far, the plan appears to have worked, said Dr. Sandra Hong, an allergist with the Cleveland Clinic. Most patients do fine with shots at longer intervals; instead of every four weeks, they get them every three months. And after three to five years of treatment, many can be weaned from the venom with no ill effects.

“With all the things the allergists have done, it has decreased the shortage,” Hong said.

There have been a few reports of allergists who couldn’t get supplies of venom, and patients who couldn’t get the product, which costs about $70 for induction doses and about $20 for each maintenance dose. So far, there are no known cases of adverse events in patients who couldn’t get shots. There’s also no sign of the skyrocketing drug prices that have occurred with other products in short supply.

Still, allergists worked to ensure that patients at the highest risk weren’t harmed. That includes people like Ciro DeMarco, 58, a retired machinist from Moxee, Wash.

DeMarco nearly died in 1983 after he was stung by a honeybee while riding a motorcycle near a river in rural eastern Washington.

“I started feeling real strange,” he recalled. “I stopped the motorcycle and sat down. All of a sudden, I had no sight and I was almost unconscious.”

He lived in fear of another sting until about 10 years ago, when he learned about VIT. Now he gets regular venom shots every three months and takes over-the-counter allergy medications before he climbs onto his Harley-Davidson. He’s relieved that the shortage hasn’t affected his supply.

“Every spring I worry about it,” he said. “But I’m not going to quit riding just in case I get stung.”

ALK Laboratories may resume production soon and the shortage could be eased in coming months. Once the supply question is resolved, Golden said, he hopes to tackle a larger issue: lack of VIT awareness among people who’ve had a bad reaction to an insect sting.

“No more than 10 percent of the affected people have sought medical attention,” he said. “Problem No. 1 is that many people, including doctors, don’t know venom immunotherapy exists.”

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Experts: North Korea latest ICBM test puts much of US in range

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PYONGYANG, North Korea — North Korea on Friday test-fired its second intercontinental ballistic missile, which flew longer and higher than the first according to its wary neighbors, leading analysts to conclude that a wide swath of the U.S., including Los Angeles and Chicago, is now within range of Pyongyang’s weapons.

Japanese government spokesman Yoshihide Suga said the missile, launched late Friday night, flew for about 45 minutes — about five minutes longer than the ICBM North Korea test-fired on July 4. The missile was launched on very high trajectory, which limited the distance it traveled, and landed west of Japan’s island of Hokkaido.

“We assess that this missile was an intercontinental ballistic missile, as had been expected,” Pentagon spokesman Navy Capt. Jeff Davis said in Washington.

Analysts had estimated that the North’s first ICBM could have reached Alaska, and said Friday that the latest missile appeared to extend that range significantly.

David Wright, a physicist and co-director of the global security program at the Union of Concerned Scientists, said in Washington that if reports of the missile’s maximum altitude and flight time are correct, it would have a theoretical range of at least 10,400 kilometers (about 6,500 miles). That means it could have reached Los Angeles, Denver and Chicago, depending on variables such as the size and weight of the warhead that would be carried atop such a missile in an actual attack.

Bruce Klingner, a Korean and Japanese affairs specialist at the Heritage Foundation think tank in Washington, said, “It now appears that a significant portion of the continental United States is within range” of North Korean missiles. Klingner recently met with North Korean officials to discuss denuclearization, the think tank said.

Washington and its allies have watched with growing concern as Pyongyang has made significant progress toward its goal of having all of the U.S. within range of its missiles to counter what it labels as U.S. aggression. There are other hurdles, including building nuclear warheads to fit on those missiles and ensuring reliability. But many analysts have been surprised by how quickly leader Kim Jong Un has developed North Korea’s nuclear and missile programs despite several rounds of U.N. Security Council sanctions that have squeezed the impoverished country’s economy.

President Donald Trump has said he will not allow North Korea to obtain an ICBM that can deliver a nuclear warhead. But this week, the Defense Intelligence Agency reportedly concluded that the North will have a reliable ICBM capable of carrying a nuclear weapon as early as next year, in an assessment that trimmed two years from the agency’s earlier estimate.

Japanese Prime Minister Shinzo Abe called the launch a “serious and real threat” to the country’s security.

Suga, the Japanese spokesman, said Japan has lodged a strong protest with North Korea.
“North Korea’s repeated provocative acts absolutely cannot be accepted,” he said.

A spokesman for Gen. Joseph Dunford, chairman of the Joint Chiefs of Staff, said Friday that Dunford met at the Pentagon with the commander of U.S. forces in the Pacific, Adm. Harry Harris, to discuss U.S. military options in light of North Korea’s missile test.

The spokesman, Navy Capt. Greg Hicks, said Dunford and Harris placed a phone call to Dunford’s South Korean counterpart, Gen. Lee Sun Jin. Dunford and Harris “expressed the ironclad commitment to the U.S.-Republic of Korea alliance,” Hicks said, referring to the U.S. defense treaty that obliges the U.S. to defend South Korea.

Prime Minister Abe said Japan would cooperate closely with the U.S., South Korea and other nations to step up pressure on North Korea to halt its missile programs.

South Korea’s Joint Chiefs of Staff said the missile reached an estimated height of 3,700 kilometers (2,300 miles) before landing at sea about 1,000 kilometers (625 miles) away. It appeared to be more advanced than the ICBM North Korea previously launched, it said.

The “Hwasong 14” ICBM test-fired earlier this month was also launched at a very steep angle, a technique called lofting, and reached a height of more than 2,500 kilometers (1,550 miles) before splashing down in the ocean 930 kilometers (580 miles) away. Analysts said that missile could be capable of reaching most of Alaska or possibly Hawaii if fired in an attacking trajectory.

South Korea’s Joint Chiefs of Staff said the missile was launched from North Korea’s northern Jagang province near the border with China. President Moon Jae-in presided over an emergency meeting of the National Security Council, which called for an emergency meeting of the U.N. Security Council and stronger sanctions on North Korea.

There was no immediate confirmation of the launch by North Korea. The day’s broadcast on state-run television had already ended when the news broke at around midnight Pyongyang time.
July 27 is a major national holiday in North Korea called Victory in the Fatherland Liberation War Day, marking the day when the armistice was signed ending the 1950-53 Korean War. That armistice is yet to be replaced with a peace treaty, leaving the Korean Peninsula technically in a state of war.

North Korea generally waits hours or sometimes a day or more before announcing launches, often with a raft of photos in the ruling party newspaper or on the television news. Kim Jong Un is usually shown at the site to observe and supervise major launches.

Late night launches are rare. North Korea usually conducts its missile and underground nuclear tests in the morning. It’s likely the North launched the missile at night and from the remote province of Jagang to demonstrate its operational versatility. To have a real deterrent, it’s important for North Korea to prove it can launch whenever and wherever it chooses, making it harder for foreign military observers trying to detect their activities ahead of time.
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Yamaguchi reported from Tokyo. Associated Press writers Robert Burns in Washington, Hyung-jin Kim in Seoul, South Korea, and Eric Talmadge in Pyongyang, North Korea, contributed to this report.

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Shell is preparing for life after oil

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LONDON — Royal Dutch Shell is planning for the day when demand for oil starts fading as major economies move away from oil and increasingly turn to electric-powered cars, Chief Executive Ben van Beurden said Thursday.

Van Beurden welcomed recent proposals to phase out passenger vehicles powered by fossil fuels in Britain and France, saying they are needed to combat global warming. Shell is looking at “very aggressive scenarios” as it makes plans to remain competitive in a world that gets more of its energy from renewable sources and less from crude oil, or “liquids,” he said.

“The most aggressive scenario – much more aggressive than what we are seeing at the moment, by the way – with maximum policy effect, with maximum innovation effect, can see us peaking in liquids consumption somewhere in the early thirties,” he said as Shell reported second-quarter earnings. “If there are a lot of biofuels in the mix, that may mean that oil will peak in the late twenties, but then everything has to work up.”

Van Beurden’s comments come amid increased focus on the future of the industry after the Paris climate agreement saw governments commit to tougher action on emissions and shareholders push for more long-term plans.

Britain this week pledged to ban the sale of new cars and vans using diesel and gasoline starting in 2040 as part of a sweeping plan to tackle air pollution. France announced a similar initiative earlier this month.

Car makers are also moving in this direction. Volvo says that by 2019 all of its cars will be powered by electricity or hybrid engines.

“It’s not a surprise that the international super-majors are starting to accept a future with the question of just how much oil and gas is needed,” said David Elmes, an energy industry expert at Warwick Business School. “They realize that is now in their planning horizons and therefore needs to be discussed with shareholders because it is influencing the decisions today, and one might argue that has been prompted by shareholder activism.”

Shell has already begun to respond to changing energy demand by increasing its focus on natural gas, van Beurden said. But the company also needs to get involved in electricity and renewable energy and expand its petrochemicals business, he said.

Van Beurden also stressed that while developed nations are moving away from gasoline- and diesel-powered passenger vehicles, the world will continue to depend on these fuels for many years.
Developing nations don’t yet have the money or electricity networks needed to shift away from fossil fuels, and aviation, shipping and trucking can’t easily shift to non-hydrocarbon energy sources, he said.

“As far as oil and gas are concerned, and certainly as far as oil is concerned, you have to bear in mind that if we have a peak and then go into decline, this doesn’t mean that it is game over straight away,” van Beurden said.

Shell’s discussion of the future came as it said second-quarter earnings more than tripled due to cost cuts and recovering oil prices.

The Anglo-Dutch energy giant said profit adjusted for changes in the value of inventories and excluding one-time items rose to $3.60 billion from $1.05 billion in the same period last year. Net income rose 31 percent to $1.55 billion.

The earnings reflect efforts to restructure the business to cope with lower oil prices and the purchase of natural gas producer BG Group. Shell’s oil price averaged $45.62 a barrel for the quarter, up 16 percent from a year earlier. Prices were above $100 a barrel as recently as 2014.

“The external price environment and energy sector developments mean we will remain very disciplined, with an absolute focus on the four levers within our control, namely capital efficiency, costs, new project delivery, and divestments,” van Beurden said.

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Report: Scaramucci has more than $50m in assets

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NEW YORK  — He vows to be a fresh voice in the Trump administration, but in one way he is like many of the others: He is wealthy, with a vast and complicated array of assets.

New White House communications director Anthony Scaramucci owns property and businesses worth more than $50 million, according to a financial disclosure report filed with the government’s chief ethics agency. The biggest source of his wealth is an ownership stake in an investment fund he founded, SkyBridge Capital.

The fund is in the process of being sold to a division of Chinese company HNA Group, a deal that has drawn scrutiny and dashed Scaramucci’s hopes to move to the White House much earlier in the year. He was turned down as chief liaison to the business community in February.

“In any administration there are always some really extraordinary wealthy individuals, but in this White House, there are so many,” said Don Fox, who stepped down as general counsel at the Office of Government Ethics in 2013. “Their finances, their potential conflicts, become exponentially more complicated to manage.”

Scaramucci joins a long list of former Goldman Sachs employees in the administration, including economic adviser Gary Cohn, chief strategist Steve Bannon and Treasury Secretary Steven Mnuchin.

SkyBridge accounted for a bulk of his income. In the nearly 18 months from the start of last year through June 27, Scaramucci took in about $10 million in salary and other income from the investment fund.

The financial disclosure also shows Scaramucci earned $88,461 as a contributor to Fox Business News.

Scaramucci expressed frustration on Thursday with the scrutiny of his personal holdings, and the conflict they may pose.

“I sold SkyBridge. I don’t work there anymore,” he told CNN’s “New Day” on Thursday morning.

“There’s residual profits that once the sale occurs I am going to receive, but I am not on salary. I do not have a W2 there. What do you want me to tell you?”

SkyBridge announced it struck a deal to sell to HNA Capital and RON Transatlantic in January. A call to SkyBridge’s spokesperson was not immediately returned.

Another issue raised by Scaramucci’s holdings involves the treatment of taxes on gains from the SkyBridge sale. Federal officials are allowed to file a so-called certificate of divestiture to defer paying taxes if they are being forced to sell an asset because of potential conflicts with their public job.

Since Scaramucci announced the SkyBridge sale long before he took his job, that raises the possibility he will fail to qualify, putting in doubt perhaps millions of dollars of profit for him.

Walter Shaub, the former head of the Office of Government Ethics and a big critic of the Trump administration, has tweeted that Scaramucci should have waited for a ruling about whether he needed to sell before entering into a deal to do so.

He tweeted on Tuesday, “U don’t qualify for employee tax relief by entering into a deal & then go looking for a job that may or may not necessitate closing the deal.”

But Richard Painter, former chief White House ethics lawyer to President George W. Bush, isn’t so sure. He said that Scaramucci may be able to qualify if owning SkyBridge is deemed a conflict before the sale is complete.

“They don’t take away the certificate of divestiture because you thought about selling before,” Painter said.

Scaramucci’s lawyer, Elliot Berke, said in an email Thursday that his client had been advised to sell SkyBridge to avoid conflicts before he stuck a deal to do so. “Throughout the review, career nonpartisan officials have recommended he be granted a certificate of divestiture, as has the White House Counsel’s office,” Berke wrote.

Scaramucci has vowed to shake up the administration in part by rooting out those who leak information to press, and the release of his personal finance report on Politico on Wednesday stoked his anger.

He took the Twitter with a vow to contact investigators.

“In light of the leak of my financial disclosure info which is a felony,” he tweeted, “I will be contacting @FBI and the @JusticeDept #swamp @Reince45.”

In fact, the report wasn’t leaked. It was released after a public records request by a Politico reporter to the Export-Import Bank, where Scaramucci had been employed at a senior level since mid-June.

The Associated Press subsequently obtained the same financial disclosure Thursday. A reporter filled out a publicly available form, turned it in at the bank’s office and was emailed a copy of Scaramucci’s financial disclosure about 30 minutes later.

The report shows that Scaramucci owns several residential properties and businesses. A stake in the New York Mets and property in the Hamptons on Long Island are each worth at least $1 million.
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AP writer Daniel Trielli contributed to this report from Washington.

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